MEDICARE: MRS. LAUREN GAIL HENRY LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180.007654	IL

General Provider Information

NPI Number	:	1093013013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN GAIL HENRY LCPC

Provider Business Mailing Address
First Line	:	2525 N SHEFFIELD AVE
Second Line	:	UNIT 1E
City	:	CHICAGO
State	:	IL
Zip	:	60614-2247
Country	:	US
Telephone Number	:	312-479-0945
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 LAKE ST
Second Line	:	SUITE 101
City	:	OAK PARK
State	:	IL
Zip	:	60301-1424
Country	:	US
Telephone Number	:	708-386-8145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	03/01/2011

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